S0453 METR0POLITAN BOROUGH OF S0UTHWARK. Inter im Report, of the Medical Officer of Health. Restive to the work of the Health Services Department during the year 1942 W. Stott. M.B., B.S., D.P.H., Medical Officer of Health. Health Services Department, Walworth Road, S.E. 17. 1 Hoalth Services Department, Walworth Road, S.E. 17. November, 1943. To His Worship the Mayor, Aldermen and Councillors, Mr. Mayor , Iadios. and Gentleman I have pleaSuro in submitting herewith my Report concerning the health of the Borough during the year 1942. In accordance with the request of the Ministry of Health that Annual Reports should bc in an abridged form, this report includos only vital statistics and other items of interest affecting the Health Department, omitting detailed statistics for each particular subject. The health of the population has been good and maintained at a satisfactory standard, there being no serious outbreak of infectious diseaso to which it is necessary to draw attention, The introduction of the Scabios Order, 1941 has proved of considerable value and has boon the means of effectually controlling the spread of the disease. Many contacts of patients suffering from scabies have been examined and where necessary treated or given preventive baths which before the coming into operation of the Order, would not have been possible. Owing to the ever Increasing demand for nursery accommodation for the children of war workers, four war-time nurseries wore opened in the Borough., and throughout the year there was a good attendance. The Maternity and Child Welfare Department continued to provide a valuable service for mothers and children living in the area, and co¬operation between the Ministry of Food's local office for the distribution of National Milk and Vitamins through the Maternity and Child Welfare Centres was arranged. The Tuberculosis Dispensary was very active during the year, and although the number of cases referred by the Army Medical Boards, etc, decroased, the total amount of work was supplemented by now facilities for X-ray examinations of the chest. This scheme' made for greater co¬operation with the general practitioners in the Borough and gave most oncouraging results in the diagnosis of early cases of tuberculosis. I am, Mr. Mayor, Ladies and Gentlemen, Yours obediently, W. STOTT. Medical Officer of Health. 2 VITAL STATISTICS 1942. Live Births Males Females Total. Logitimate 622 563 1185 Illegitimate 53 39 92 675 602 1277 Live Birth Rate:- 19,2 per thousand population. Still Births. Legitimate 17 21 38 Illegitimate 3 3 20 21 41 Still Birth Rate:- 31.1 per thousand total births. Deaths. 773 485 1258 Death Rates- 18.9 per thousand population. Rate per thousand Live and still births. Materna1 Deaths. Deaths Prom Puerperal Sepsis 1 0.76 Other Puerperal Causos 2 1.52 Infant Deaths (under one year) Death Rate. All Infants - per thousand live births 61 Legitimate Infants - per thousand live legitimate births 60 Illegitimate Infants - per thousand live illegitimate births 76 Doaths from: Measles (all ages) 1 Cancer (all ages) 189 Whooping Cough (all ages) 2 Diarrhoea (under 2 yrs of ago) 21 Classification of Doaths. The causes of death (773 males and 485 females) were as follows:- Whooping Cough 2 Diphtheria 2 Tuberculosis of the respiratory system 77 Other Tuberculous diseases 4 Syphilitic diseases 23 Influenza 7 Measles 1 Acute Infective Encephalitis 1 Cancer 189 Diabetes 4 Intra-Cranial Vascular Lesions 84 Heart Disease 341 Other Circulatory Diseases 38 Bronchitis 97 Pneumonia 67 Other respiratory diseases 14 Peptic Ulcer 13 Diarrhoea 21 Appendicitis 4 Other digestive diseases 32 Nephritis 32 P. T. 0. 5 Puerperal Sepsis 1 Other maternal causes 2 Premature births 23 Conjenital malformations and birth injuries 10 Suicide 7 Road Traffic Accidents 20 Other Violent causes 49 All other causes 93 Total deaths at all ages 1,258 AGE GROUPS Under 1 1 to 4 5 to 14 15 to 44 45 to 64 65 and Total over Males 53 12 10 70 245 333 773 Females 25 7 6 59 111 277 485 78 19 16 129 356 660 1258 Infant Mortality, The total number of deaths of infants under one year of age was seventy-eight, the causes of death being as follows:- Whooping Cough 1 Tuberculosis of the respiratory system 1 Bronchitis 7 Pneumonia 15 Diarrhoea 19 Premature births 23 Conjenital malformations and birth injuries 7 Other violent causes 1 All other causes 4 78 Maternal Mortality. One death was attributed to Puerporal Sepsis and two others to maternal causes, Mortality Rate:- 2.28. Maternity and Child Welfare. Homo Nursing: 860 visits to sick children and to cases of homo confinement wore made under arrangements with the local Nursing Associations. Home Visiting, The Health Visitors made 28,847 visits to the homos of expoctant mothers, infants and toddlers. Welfare Centre Attendance. Examinations of Expectant Mothers by Medical Officer 5,225 Examinations of Post Natal cases by Medical Officer 1,187 Attendances of Infants under one year 13,328 Attendances of Children one to five years 7,537 The Assistant Medical Officers examined 9,960 children during the year Continued 4 CHILD LIFE PROTECTION. At the end of the year there wore three persons on the register who woro receiving children for reward, and there were three foster children being cared for by foster mothers. The Child Life Protection Visitor made thirty-five visits to the homes of foster mothers. Four now foster mothers wore registered during the year, two women who were not registered foster mothers were found to bo taking children for reward and cautionary letters were sent in those instances. The names of five foster mothers wore removed from the register, three at their own request, one by legal adoption of the foster child and another because of illness of the foster mother and subsequent death. In the latter case, the foster child was removed to a nursery temporarily and was later legally adopted, The names of four now foster children were added to the register and five were removed during the year. The health of the faster children in the district remained generally good and no child died, HOME HELPS. Home Helps were provided in eighteen cases of home confinements. WAR TIME NURSERIES. There were in the Borough, at the close of the year, four war time nurseries, three under the direct control of the Council on behalf of the Ministry of Health, and one under the control of the London County Council Rest Centre Service, the admissions to the four nurseries being supervised by the Council, The number of places provided were as follows:- Under 2 Over 2. Crossways War-Time Nursery, New Kent Road. 15 30 Bishop's House War Time Nursery, Kennington Park Place. 20 50 Evelina War Time Nursery, Southwark Bridge Road. 40 10 Clubland War' Time Nursery, (L.C.C Rest Centre) Cambcrwoll Road. - 20 75 110 The health of the children in the nurseries was generally good and there was a satisfactory attendance of those whose names were on the register. In addition to these nurseries, there were two residential war time nurseries in country areas which were maintained by the Surrey County Council, by arrangements with this Authority, These nurseries were situated at Whitnorth, Shalford, Surrey and at Tilford Convalescent Homo, Tilford, Surrey, each having accommodation for forty Southwark children. Women's Country Ho1iday Fund. Sixteen women and fifteen children were sent for convalescence under this scheme. Solarium - Health Services Department. 125 children under 5 years of ago were treated in the Solarium at the request of the Council's Medical Officers, a total of 1,774 attendances being made. Cenvalescent Treatment. 64 children were sent away by arrangement with the Invalid Children's Aid Association. Extra Nourishment. 423 dinners were provided to children, necessitous expectant and nursing mothers. Continued 9 Dental Clinic, There was a good attendance of patients who had been referred to the Clinic by Medical Officers of the Maternity and Child Welfare Centres. The number of now patients soon were:- Expectant mothers 57 Nursing mothers 16 Children 70 The attendances at the Clinic were:- Expectant mothers 278 Nursing mothers 140 Children 98 Fifty-two sessions were hold during the year. Vaccination. The total number of certificates and copies of certificates of successful primary vaccination received during the year 1942 was:- Northern Division 268 Southern Division 466 754 Sanitary Circumstances of the Area. The work of supervising the sanitary condition of the district, including the inspection of common lodging houses, factories and workshops was carried out by the sanitary inspectors during the year. In addition there was periodic inspection of the air raid shelters in the Borough, particular attention being paid to the larger shelters where the nightly population exceeds 500 persons. Inspections wore also made at frequent intervals of places used for the reception of sheltorers' bedding, and the disinfection and disinfestation of those promises and the bedding stored, carried out in all cases where this was necessary. Sanitary Work. Number of Complaints 5,170 Inspections, house to house 125 Miscellaneous Visits 1,049 Inspections of shelters 2,927 Inspections of war damaged promises 1,509 Inspections of Factories 1,282 Inspections of Shops 29 Visits ro: Billeting 229 Common Lodging House Visits 46 Smoke Observations 2 Inspection of Wardens Posts 59 Inspection of Rest Centres 16 Inspection of Bombed Sites, etc. 49 Re-visits 12,062 Number of Intimation Notices Served 1,701 Number of Statutory Notices Served 446 Number of Defects found and remedied 4,720 Public Health (London) Act, 1956 - Section 224. One person was removed to an Institution upon. an Order of the Court, Continued 6 Common Lodging Houses. The - inspection of the so promises was carried out at frequent intervals, and nuisanees were abated. In several instances. In few cases evidence of lice was found and notices under the Scabies Order, 1941 were served on the lodgers cencerned who were subsequently treated at tho Council's Treatment and Bathing Centre, and the bedding disinfested. One Common Lodging House for men was closed, the promises being insanitary and unfit for reconditioning. Factories. The inspection of factories was regularly carried out and nuisances where found were abated. In a few instances additional W.C. accommodation had to be provided for increased staffs, whilst in one or two eases permission was granted for the use of temporary accommodation as an emergency measure. Rats and Mice Destruction. During 1942, probably due to quieter conditions following air raidings, rats commenced to come back to their old haunts and more complaints were received than in 1941, A number of defects in drains and sewers as the result of war damage were the contributing factor to a number of Infestations. Throughout the year, the systematic laying of poisoned baits in the Council's sewers was continued, but there was a little difficulty during the summer in obtaining supplies of red quill and barium, the chief source of supply of the former poison being from countries In enemy bands., Some difficulty was also experienced in obtaining waste fat for making up paste baits, but by the assistance of the Ministry of Pood it was possible to overcome this problem. On the 30th Aprils the Ministry of Food took over the powers concerning redent repressions from the Ministry of Agriculture and Fisheries. This transfer of powers resulted in a speeding up of activity for the destruction of rats and mice. Summary of Inspections and investigations made during the year:- Complaints received 470 Premises cleared 145 Inspections by Rat inspector 654 Re-inspections by Rat Inspector 2,851 Inspections by Rodent Officer (Food Promises) 314 Re-inspections of Food Promises 71 Smoke Tests 232 Defects found in drains or sewers 160 Baits laid in sewers 9,650 Other baits laid 21,388 Break-back traps set 1,770 Cage traps sot 168 HOUSING-. During the year there was a very large increase in the number of applicants for housing accommodation due principally to applicants accommodation becoming illegally overcrowded; caused by the return of relatives from evacuation areas or in a number of Instances to the desire of people who had been evacuated to neutral areas, to again become residents of Southwark. Another type of applicant was the young married couple who upon marriage did not set up a home, but continued to live with parents, the husband having boon called up for service in His Majesty's Forces. In some cases the husband had received his discharge from the Forces whilst in others children had been born Of the marriage, thus causing immediate overcrowding in the parents' home. Continued 7 Housing (Continued) Every endoavour was made do to find suitable accommodation in the worst eases but the problem is far from solved and the cessation of hostilities will undoubtedly result in large numbers of families clamouring for better accommodation. It will bo necessary for the Government to review the present housing situation and to formulate the moans for rapid construction of now dwellings at the earliest possible time and also to provide, for the reconditioning of property damaged by enemy action. Whilst endeavouring to preserve the better typo of property, in my View no large sums should he spent on houses which are of bad construction or would otherwise have come under clearance schemes. To do so would be to prejudice future development schemes, Inspection and Supervision of Food. Careful attention has been given to all matters relating to the utilisation of damaged food and complete co¬operation has been maintained with the Food Executive Officer for the District. Largo quantities of food, especially canned goods, that had boon reported as unfit for human consumption, have on examination been found to bo fit for human consumption, although it would not have been desirable for such food. to have boon sold in the shops. It was disposed of under proper safeguards to Institutions, Canteens and for manufacturing purposes. Food that was found to be unfit for human consumption was reported to the Local Food Committee, who disposed of same to the Ministry of Food's Salvage Section, Close co¬operation concerning all matters connected with food has existed throughout the year between the Ministry of Food and my Department, The total quantity of food destroyed amounted to some 146 tons. Public Health (Imported Food) Regulations, and Public Health (Preservatives) in Food Regulations. Duties under these Regulations, although somewhat limited were carried out as necessary, samples for examination being taken as required and submitted to the Public Analyst. Mortuary and Coroner's Court. Post-Mortems conducted - without inquest 514 Post-Mortems conducted - with Inquest 127 Inquests hold, Post-Mortems conducted elsewhere 39 Bodies brought in for convenience 2 482 Verminous Persons. During the year there was a total attendance of 14,932 persons for bathing and treatment. Of this number 6,782 were treatments given to children in accordance with the Council's Agreement with the London County Council. 8,150 treatments and baths were given to persons sent from various Common Lodging Houses, Hospitals and local practitioners. Many additional treatments have been given during the year following upon enforcement of tlx Scabies Order, 1941. The following figures indicate the groat increase in the work undertaken in connection with Scabies treatment and prevention. For comparison the figures for 1941 are also given:- Continued 8 SCABIES Men Woman Children Total First Quarter " (1941) 599 (384) 985 (490) 1078 (404) 2662 (1278) 2nd Quarter " (1941) 536 (315) 1160 (434) 1120 (374) 2816 (1123) 3rd Quarter " (1941) 562(327) 1495 (566) 1082 (513) 3139 (1406) 4th Quarter „ (1941) 531 (445) 1494 (768) 1484 (779) 3509 (1992) Total 2228 (1471) 5134 (2258) 4764 (2070) 12126 (5799) VERMINOUS. 1st Quarter 195 46 458 699 2nd Quarter 161 69 482 712 3rd Quarter 115 74 553 742 4th Quarter 69 69 525 663 540 258 2018 2816 Verminous Promises . During the year 1,087 verminous rooms and. their contents were treated by the disinfecting staff. Council houses found infested 1 Council houses disinfested 1 Other premises found to bo infested 557 Other promises disinfested 557 Verminous Bedding Disinfested. Disinfested Destroyed Beds 248 22 Palliasses 2206 33 Bolsters and Pillows 3401 41 Cushions 345 17 Blankets 8803 1 Sheets 1734 2 Quilts 1165 3 Articles of clothing, etc. 12,0508 296 Total 138,410 415 In addition one ton thirteen hundredweights of miscellaneous articles and household effects were destroyed. Disinfection. The total number of disinfections of rooms during the year by the Council's Disinfecting staff was 421. Of this number 385 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, and 36 after cases of pulmonary tuberculosis. Continued 9 Disinfection - Infectious Disease, Disinfected Destroyed. Beds 200 1 Palliasses 164 3 Bolsters 142 2 Pillows 518 1 Cushions 72 Blankets 612 Sheets 352 Quilts 333 Articles of clothing, etc. 992 3 Books 175 Total 3,560 10 In addition 477 Its of brisles were disinfected. Food & Drugs Acts. The following samples of food and also drugs were taken by the Inspectors and their agents and submitted to the Public Analyst:- No, of formal samples taken 1185 No, of formal samples adulterated 5 No, of informal samples taken 1178 No, of informal samples adulterated 29 Analysis of Samples. No, of Sample Examined. No, Adult rated Total Formal Informal Total Formal Informal. Milk and Milk Products 451 2 453 2 2 Oils, Fats, etc. 95 12 107 Canned and Potted Foods 3 5 8 Meat and Meat Products 104 242 346 Fruits and Vegetables, canned etc. 2 35 37 Preserves, Jams, Jellies, etc. 37 10 47 1 1 Cereals & Cereals Preparations 103 95 198 2 7 9 Broad, Flour & ery 73 236 Wines, Spirits and Beverages 108 93 201 1 5 6 Condiments, Spices, Sauces, etc. 119 138 257 1 1 Drugs and Medical Preparations 14 133 147 11 11 Miscellaneous Samples 76 177 253 4 4 Total 1185 1178 2363 5 29 34 Percentage of adulterated samples 1.43 Continued 10 Legal Proceedings - Food and Drugs Act, etc. Defendant Cause of Proceedings. Result. Irene Mee "Duke of Clarence P.H. 132, London Road, Selling whiskey 50.5° under proof. Fined £10 and £10,10,0 costs James Lewis, 7, Nicholson Street. Selling milk containing 30% added water. Fined £8 and £5.5.0 costs. James Lev/is, 7, Nicholson Street, Selling milk containing 29% added water, Fined £8, and £5.5.0 costs. Legal Proceedings - Public Health Acts, etc. John Edgington, 8, Ponton Place. Foul condition of room and contents. Abatement and Prohibition Orders. Milksollors, Retailors and Wholesalers In the Borough 227 Retailers and Wholesalers elsewhere 134, Milk (.Special Dos lunations ) Order Principal Licenses 43 Supplementary Licenses 12 INFECTIOUS DISEASES The notifications of infectious diseases received during the year numbered 1,318 (excluding Tuberculosis) as follows:- Scarlet Fever 240, Diphtheria 80, Enteric Fever 5, Paratypoid Fever 1, Puerperal Fever 1, Puerperal pyrexia 9, Cerebro - spinal Fever 4, Measles 621, Whooping Cough 208, Dysentery 7, Epidemic Diarrhoea 15, Pneumonia 77, Ophthalmia Neonatorum 3, Erysipelas 47. 27 deaths due to infectious diseases were recorded:Whooping Cough 2, Diphtheria 2, Measles 1, Acute infective, encephalitis 1, Diarrhoea 21. Diphtheria Immunisation. Immunisation against diphtheria was carried out in the Council's Diphtheria Immunisation Clinics and by general pratitioners in accordance with the Council's Scheme for Doctors, The total number of children given preventive injections during the year was 2,187 of whom 570 were under the age of 5 years, Tuberculosis. 253 notifications of tuberculosis were received, of which 187 were in respect of pulmonary eases and 66 non-pulmonary. According to the return supplied by the Registrar General the number of deaths from tuberculosis was 81, 77 being pulmonary and 4 non-pulmonary. Continued 11 TREATMENT OP TUBERCULOSIS DIAGNOSIS PULMONARY NON-PULMONARY TOTAL GRAND TOTAL Adults Children Adults Children Adults Children M F M F M F M F M F M F A. New cases examined during the year (excluding contacts) (a) Definitely Tuberculous 50 41 4 4 8 3 2 9 58 44 6 13 121 (b) Diagnosis hot completed 39 26 3 2 1 - 1 - 40 26 4 2 72 ( c) Non-tuberculous 136 115 12 7 — 1 — — 136 116 12 7 271 B. Contacts examined during the year:- (a) Definitely Tuberculous 2 8 2 1 - 1 - - 2 9 2 1 14 (b) Diagnosis not completed 4 11 6 6 - - - - 4 11 6 6 27 (c) Non-tuberculous 25 56 22 24 — — 1 — 25 56 23 24 128 C. Cases written off the Dispensary Register as (a) Recovered - 2 - - 1 - 2 1 1 2 — - 2 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - 1 - - - 1 - - - 2 - - 2 D. Number of cases on Dispensary Register on December 31st. (a) Definitely Tuberculous 431 294 51 53 24 29 4 5 455 323 55 58 891 (b) Diagnosis not completed 43 37 9 8 1 - 1 - 44 37 10 8 99 12 1. Number of cases on Dispensary Register on 1st January 880 2. Number of case3 transferred from other areas and cases returned after discharge under head 3 in previous years 35 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases lost sight of 109 4. Cases written off during the year as dead (all causes) 42 5. Number of attendances at the Dispensary (including contacts) 4,391 6. Number of insured persons under Domiciliary Treatment on December 31st 7 Number of consultations with medical Practitioners:- (a) Personal) (b) Others ) 410 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 40 9. Number of visits by nurses or Health Visitors to homes for Dispensary purposes 1,785 10. Number of (a) specimens of Sputum etc. 483 examined (b) X-ray examinations made in connection with Dispensary work (i ) Screenings 614 (ii) Films 916 A.P. Re-fills 1,100 11. Number of 'recovered' cases restored to Dispensary Register and Included in (A) (a) and (A) (b) above 12. Number of T.B Plus' cases on Dispensary Register on December 31st 362